Provider Demographics
NPI:1316191356
Name:JOHNSTON, LISA O (RD/LD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:O
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S STATE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3626
Mailing Address - Country:US
Mailing Address - Phone:405-241-5836
Mailing Address - Fax:
Practice Address - Street 1:1601 S STATE ST
Practice Address - Street 2:STE 500
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3698
Practice Address - Country:US
Practice Address - Phone:405-509-1294
Practice Address - Fax:405-562-8735
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered